POTHRANJENOST BOLESNIKA NA DIJALIZI

Many factors contribute to morbidity and mortality in patients with end-stage renal disease, one of these being malnutrition. Eating disorders are inevitable in patients with uremia. A common associated factor is inflammation with hypoalbuminemia and decrease in serum proteins. In the present study, data on 33 (38.37%) female and 53 (61.63%) male patients were assessed with standard statistical analysis including the R-test for normality. The assessment method used was the Malnutrition Inflammation Score (MIS) composed of 10 components. The mean patient age was 67.28±12, range 32-86 years. The mean duration of hemodialysis (HD) was 48.94±47.57, range 3-224 months. The MIS has three categories: (A) well nourished; (B) mild malnutrition; and (C) severe malnutrition. At the beginning of the study, results were as follows: (A) 6.98%; (B) 51.16%; and (C) 41.86%. The respective figures recorded after 6 months were as follows: (A) 10.47%; (B) 25.58%; and (C) 63.95%. During the study, 53.49% of patients had a MIS of 7 or more, 6.97% of patients passed away, and 3.49% underwent transplantation. The mean MIS was 20.3±1.63 in the deceased, 3±2.6 in the transplanted, and 7.98±5.7 in the rest of patients. Patients having undergone HD for at least 3 months and aged at least 18 years were included in the analysis. The objective of the study was to determine the rate of malnutrition among HD patients and to compare the results recorded in our center with other HD centers around the world. Furthermore, our aim was to compare MIS with mortality rate. We repeated MIS after 6 and 12 months to find out whether there would be a decrease in the rate of malnutrition among patients, since additional nutritional support was introduced after detection of the state. According to our study results, there is strong correlation of malnutrition, hospitalization and mortality.Poznato je da teške bolesti uzrokuju gubitak apetita, tjelesne težine i malnutriciju. Uremija je teška bolest i čest pratilac pothranjenosti. Uzroci tome su višestruki: ograničen unos bjelančevina, gubitak bjelančevina uz još očuvanu diurezu. Sama hemodijaliza potiče katabolizam proteina i eliminira neke hranjive tvari te djeluje proupalno. U Centru za kroničnu hemodijalizu svih ispitanika liječenih najmanje 3 mjeseca i starijih od 18 godina napravili smo presječnu analizu. Željeli smo vidjeti kolika je zastupljenost pothranjenosti i u kojoj je korelaciji sa svjetskim podatcima te koliki je utjecaj visine ispitivanog zbira na smrtnost. Ponavljanjem testa nakon 6 i 12 mjeseci očekivali smo smanjenje stupnja pothranjenosti s obzirom na nutricionističku potporu nakon otkrivanja stanja, a na osnovi kojeg se podizala svijest o tom problemu kod bolesnika, obitelji i osoblja, naročito iz područja prehrane i tjelesne aktivnosti. U analiziranim podatcima na prvi pogled došli smo do poražavajućih rezultata u smislu porasta pothranjenosti u prvih 6 mjeseci. Daljnja analiza je pokazala da je pothranjenost bila uglavnom uzrokovana komorbiditetom povezanim s malignitetom te visokom dobi. Logično je da je uočena velika razlika u Malnutrition Inflammation Score (MIS) između umrlih i transplantiranih bolesnika. Kod umrlih bolesnika zbir MIS je bio 20,3±1,63, kod transplantiranih 3±2,6, a kod svih ostalih 7,98±5,7. Ne smijemo zaboraviti da se prema nekim autorima u literaturi navodi učestalost pothranjenosti kod bolesnika na dijalizi od 70% i više

POSEBNOST DIJALIZE u STARIH I VRLO STARIH BOLESNIKA – DILEME

The global increase in the proportion of older population contributes to the increasing number of patients with renal insufficiency. This disorder particularly involves the old (age 70-75) and very old (over 80) population groups. The number of comorbidities is increasing and life expectancy reduced with aging. Cross-sectional analysis of ten-year survival showed a rate of 33.9% in patients treated at the Hemodialysis Center, 23.81% in transplanted patients and 19.35% in dialyzed patients. In patients having started hemodialysis (HD) at the age of ≥70, the mean survival was 20.27±18.62 months, in those that died 15.54±17.35 months, and in survivors 30.29±17.85 months. Among HD treated patients, 35% survived for up to one year, 18% for two years and 8% for ≥3 years. Karnofsky index was below 50% in all patients that survived, while the Malnutrition Inflammation Score and Subjective Global Assessment indicated malnutrition. In Croatia, the number of HD patients is constantly increasing as the result of population aging, better, accessible and equal health care that prolongs life span, easier access to substitution methods, more accesses to the vascular system, development of the national transplant network and good immunosuppressive therapy. All this provides biological, economic and normative space for replacement therapy. Old age, comorbidities and poor nutritional status influence high mortality, poor functional status and impaired quality of life. Survival results correspond to reports in the literature.U svijetu je ubrzan porast broja starijih bolesnika koji trebaju liječenje dijalizom. Ti se izvještaji poklapaju iz raznih zemalja. Problemi koje nosi starija dob su višestruki. Različiti su stavovi za stratifikaciju dobnih granica. Bilo kako bilo, dobne granice su produžene i porast starije populacije sa svim pratećim komorbiditetima je neizbježan. Kronična bubrežna bolest ima puno veću incidenciju u među starom negoli među mlađom populacijom i u stalnom je porastu u svijetu bilo kao bolest, komorbiditet ili posljedica raznih stanja. Ova činjenica nameće pitanja fiziologije i patofiziologije starenja i promjena u glomerularnoj filtraciji (GF). Ima li jasnih stavova o normalnim laboratorijskim vrijednostima prilagođenim dobnoj granici? U kojem stupnju je GF fiziološka varijanta za konkretnu dob? Produžava li liječenje hemodijalizom životni vijek vrlo starih osoba? Odgovori nisu uvijek precizni. Stara populacija često je izložena odlukama liječnika, obitelji ili skrbnika mimo svoje želje, bilo zbog nedostatka komunikacije ili zbog nepoznavanja postupaka. Procedure mogu na bolesnika ostaviti psihičke i fizičke posljedice (patnje), bez obzira na to što su sve napravljene profesionalno, oni često kažu “da sam znao što me čeka, ne bih pristao”. Zbog toga je nužno poštivati odluku bolesnika. Analizom vlastitih podataka vidljiva je prisutnost veoma stare populacije s velikim brojem pridruženih komorbiditeta te visokim stupnjem pothranjenosti (MIS) i Karnofskyjeva skora. U Centru je više od 49,23% populacije starije od 70 godina, s velikom zastupljenošću privremenog ili trajnog centralnog venskog katetera kao pristupa za dijalizu (42,35%). Najviše preživjelih do 1, 2 i 3 godine bilo je u skupini od 76-80 godina, a u skupini starijih od 80 godina nitko nije preživio 4 ili 5 godina. Kod preživjelih bolesnika visoke dobi sposobnost za samostalno funkcioniranje je veoma mala. Karnofskyjev zbir za preživjele 6 mjeseci i više bio je u prosjeku 50%

Generalizirana ateroskleroza, metabolički sindrom i rezistentna hipertenzija - uzroci i posljedice

e components of metabolic syndrome lead to generalized atherosclerotic changes and micro- and macrovascular complications with damage to systems and organs. Consequently, patients’ treatment with the resulting changes in the target organs is costly, complicated, and unpredictable. We present a 65-year-old patient with diabetes diagnosed with hyperlipidemia, unregulated arterial hypertension in the presence of other metabolic syndrome components and who consequently developed complications of generalized atherosclerosis. Despite detailed, individually tailored therapy, in line with current recommendations, we suggest that treatment success is very closely related and dependent on dietary measures, healthy living habits, and patient cooperation.Komponente metaboličkog sindroma dovode do generaliziranih aterosklerotskih promjena te mikro i makrovaskularnih komplikacija s oštećenjem sustava i organa. Slijedom toga, liječenje bolesnika s posljedicama promjena na ciljnim organima vrlo je skupo, složeno i nepredvidljivo. Predstavljamo 65-godišnjeg pacijenta, dijabetičara, kojem je dijagnosticirana hiperlipidemija, neregulirana arterijska hipertenzija u prisutnosti drugih komponenata metaboličkog sindroma i posljedično razvijene komplikacije generalizirane ateroskleroze. Unatoč detaljnoj, individualno prilagođenoj terapiji, u skladu s trenutnim preporukama, smatramo da je uspjeh liječenja vrlo usko povezan i ovisi o prehrambenim mjerama, zdravim životnim navikama i suradnji pacijenta

Decentralizacija i municipalne vlasti u zemljama jugoistočne Europe

True this paper it would be analyzed sub-municipal government as a organizational form of local governance with comparative perspective, and elements which generally formed sub-municipal government as a tools for delivery of local public services and managing of local initiatives which are important for the local community. These two roles are crucial for understanding of dynamic in sub-municipal government. Special focus would be held on sub-municipal government in South- Eastern European countries, which they have a common history and institutional framework, with the main question: how can sub-municipal government contribute to strengthening of decentralization and democratic processes in the local community directly and, indirectly in whole society. Self-government systems which are highly decentralized usually have developed sub-municipal government. On the other side, in centralized countries sub-municipal government usually has reduced role which is connected with managing of public tasks connected with local community needs. The main question is how sub-municipal government can improve decentralization, and how those efforts at the end of the day contribute to better development of whole society.U radu se analizirala institucija podopćinskog poglavarstva kao organizacijski oblik lokalne uprave sa komparativnom perspektivom i elementi koji su općenito činili podopćinsku vlast kao oruđe za pružanje lokalnih javnih usluga i upravljanje lokalnim inicijativama važnim za lokalna zajednica. Ove dvije uloge su ključne za razumijevanje dinamike u podopćinskoj vlasti. Poseban fokus stavljen je na podopćinske vlasti u zemljama jugoistočne Europe, koje imaju zajedničku povijest i institucionalni okvir, s glavnim pitanjem: kako podopćinska vlast može pridonijeti jačanju decentralizacije i demokratskih procesa u lokalnoj zajednici izravno i neizravno u cijelom društvu. Sustavi samouprave koji su visoko decentralizirani obično imaju razvijenu podopćinsku upravu. S druge strane, u centraliziranim zemljama podopćinska vlast obično ima smanjenu ulogu koja je povezana s upravljanjem javnim zadacima povezanim s potrebama lokalne zajednice. Glavno pitanje je kako pod-općinska vlast može poboljšati decentralizaciju i kako ti napori na kraju dana doprinose boljem razvoju cijelog društva

Analysis of the Digital Divide in the Telecommunication Services Using Knowledge Discovery in Databases

In this paper, the digital divide in the telecommunication services between 28 member states of the European Union in the period from 2007 to 2011 has been analysed using methods of knowledge discovery in databases. A brief history of telecommunications and essential telecommunication services has been presented, as well as their characteristics. Data related to the indicators of the digital divide in the telecommunication services has been collected and subjected to descriptive analysis. After choosing an optimal set of variables and a method, cluster analysis has been performed for each of the five years of the study period. Groups of EU member states at a similar stage of development of telecommunications have been identified and the characteristics of each of the groups have been described. Additionally, the paper presents some conclusions about changes in the scale of the digital divide in the telecommunications services between EU countries during the study period. This work is licensed under a&nbsp;Creative Commons Attribution-NonCommercial 4.0 International License.</p

RAZVOJ MJESNE SAMOUPRAVE U ZEMLJAMA JUGOISTOČNE EUROPE

Local self-government is established as an institutional answer to create balance to the central government and improve democratic and development processes in the local community and the entire national society. On the other hand, sub- municipal government is established as a part of local political decentralization, with the aim of strengthening local political and administrative institutions of local government units. Both can be institutional solutions and an answer for initializing and supporting democratic processes in contemporary society. This article provides analysis of relations between political decentralization in local community and sub-municipal government as a tool for strengthening local political institutions in South-Eastern European countries. This analysis aims to show that sub-municipal government can be also a significant institutional instrument for changes in the local community.Lokalna samouprava je uspostavljena kao institucionalni odgovor u pravcu kreiranja ravno- teže prema središnjoj državnoj vlasti, kako bi se unaprijedili demokratski i razvojni procesi u lokalnoj i široj društvenoj zajednici. S druge strane, mjesna samouprava je uspostavljena kao dio procesa lokalne političke decentralizacije, s ciljem jačanja lokalnih političkih i uprav- nih institucija koje predstavljaju organizacijsku strukturu lokalne samouprave. Obje mogu predstavljati institucionalnu mogućnost i odgovor u iniciranju i podupiranju demokratizacij- skih procesa u suvremenom društvu. Ovaj rad iznosi analizu odnosa koji nastaju kao rezultat političke decentralizacije u lokalnoj zajednici i ulogu koju mjesna samouprava zauzima kao sredstvo za jačanje političkih institucija u zemljama Jugoistočne Europe. Analiza također po- kazuje kako mjesna samouprava može biti značajan institucionalni alat za iniciranje promjena u lokalnoj zajednici

Ometanje dječjeg likovnog stvaralaštva

Od najranije dobi, na razne načine, djeca zadovoljavaju svoju potrebu za stvaralaštvom. Svako dijete u jednom trenutku počinje istraživati svijet oko sebe. U tom razdoblju počinje se zanimati za boje, linije i mrlje te ih pokušava samo stvarati. U to isto vrijeme, kada dijete tek otkriva svoju likovnost, postoji opasnost od sputavanja djetetove kreativnosti. To se može dogoditi na razne načine: nekvalitetnim bojankama koje su pune šablonskih oblika, gledanjem animiranih filmova čiji su likovi pretjerano pojednostavljeni, crtanjem djeci kako bi ih se naučilo crtati i još mnogo toga. U prvom poglavlju pod nazivom „Likovni jezik“ govori se o početcima likovnog jezika kod djece, likovnim simbolima i o tome što oni djeci predstavljaju i kako se njima služe za prikazivanje određenih oblika, njihovih funkcija te o sveprisutnosti kiča. U drugom poglavlju „Ometanje stvaralaštva“ predstavljeni su čimbenici koji negativno utječu na dječju kreativnost i izražavanje, motivaciju te koji su najčešći motivi dječjih crteža. Treće poglavlje „Poticanje stvaralaštva“ razmatra razvoj likovne kreativnosti djece i kako učitelji mogu na to utjecati. Zadnje poglavlje odnosi se na istraživanje koje je provedeno u dvije osnovne škole na uzorku od 53 učenika. Cilj istraživanja bio je otkriti kako na dječje likovno stvaralaštvo djeluje uplitanje odraslih te preuzimaju li djeca šablonske oblike jedni od drugih. Rezultati istraživanja pokazuju da su šablonski oblici rašireni među djecom i da se uplitanjem u njihovo likovno stvaralaštvo može znatno utjecati na razinu kreativnosti.From the earliest age, in many ways, children meet their creative need. Every child at one point begins to explore the world around. In this period, child begins to be interested in paint, lines and smudges and tries to create them. At the same time, when a child discovers his art, there is a danger of stifling the child's creativity. This can happen in various ways: low-quality coloring books full of template shapes, watching cartoons whose characters are overly simplified, teaching children how to draw and more. In the first chapter titled "Art Language", we speak of the beginnings of visual arts in children, art symbols and what they represent to children and how they serve them to represent certain forms, their functions, and the omnipresence of the kitsch. In the second chapter, "Hindering of creativity", are presented factors that negatively affect children's creativity and expression, motivation and the most common motives of children's drawings. Chapter Three "Encouraging Creativity" examines the development of artistic creativity of children and how teachers can influence it. The last chapter refers to the research conducted in two primary schools on a sample of 53 students. Research goal was to find out how adults interference affecting on children's artistic creativity and do the children take template shapes one from the other. Research results show that template shapes are spread among children and that interfering with their artistic creativity can significantly affect the level of creativity

METHODS TO FIGHT MENTAL ILLNESS STIGMA

Mental illness stigma is still widely spread and present in all the cultures and nations. Even more, during the last half of century there hasn\u27t been much change in the perception of mentally ill persons as "incurable and dangerous individuals incapable of living on their own". The significance of mental illness stigma is determined by the size of its negative effect on mentally ill individuals, their family members, and the psychiatric service as well as on the society as a whole. In order to reduce the negative effects of stigma on the life of mentally ill individuals as well as to provide equal lifestyle in the community, at the beginning of the 1990s the World Health Organization recommended a global and decisive fight against the mental health stigma and discrimination. Since then three effective methods proliferated in fighting the mental illness stigma. These methods consist of combining education, contact with stigmatized group representatives and protest. To achieve better efficiency of anti-stigma program, the fight should be led by citizens of all age groups, especially younger people, the media, health care providers involved in treating the patients, but also the patients themselves as well as their family members